CARE HOMES FOR OLDER PEOPLE
Clara Nehab House 13-19 Leeside Crescent Golders Green London NW11 0DA Lead Inspector
Tony Brennan Key Unannounced Inspection 31st May 2007 11:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Clara Nehab House DS0000010422.V333444.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Clara Nehab House DS0000010422.V333444.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Clara Nehab House Address 13-19 Leeside Crescent Golders Green London NW11 0DA Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8455 2286 020 8455 2120 Leo Baeck Housing Association Limited Mr David Lightburn Care Home 25 Category(ies) of Old age, not falling within any other category registration, with number (25) of places Clara Nehab House DS0000010422.V333444.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 23rd November 2006 Brief Description of the Service: Clara Nehab House is registered to provide care for twenty-five older people. The Leo Baeck Housing Association operates the home. The accommodation is provided on three floors in twenty-five single en suite bedrooms. The lounge/dining room and an additional lounge is on the ground floor. The home is located in a residential area with shops and access to public transport close by. The original aim of the home was to provide care for people who had suffered Nazi oppression. Service users admitted to the home more recently may not have had that direct experience but choose to live there because the background ethos is relevant to their personal experience as the home maintains practices that meet the needs of service users from a Jewish background. The fees are £705 a week. This report is available through the internet. Copies may also be obtained from the provider of this service. Clara Nehab House DS0000010422.V333444.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced key inspection was undertaken as part of the annual inspection programme. I sought to confirm that the areas for improvement identified at the last Random inspection were addressed. The inspection took place over one day. David Lightburn, the registered manager, assisted me with the inspection. I spoke with the five people who live at Clara Nehab House and three members of staff. I observed care practice and interaction between people living at the home and staff. I toured the building and examined a number of records relating to the care, health and safety and management of the home. I would like to thank David Lightburn and all the staff who assisted me by answering questions about the running of the home. I would also like to thank the seven people who live at the home who discussed their views of the service they receive. What the service does well:
The statement of purpose also identified the skills and staffing resources that are to be available to meet the needs of people living at home. Clara Nehab House provides care for people of the Jewish faith. People spoken to told me that the home meet their religious and cultural needs. The home support people in the practice of the Jewish faith ensuring that contact is maintained with local synagogues and the wider Jewish community. Training had been provided in the religious, history and culture of the Jewish people. People who live at the home told me they felt that staff understood their cultural and religious needs. Two of the people case tracked had recently come to live at the home. They had detailed assessments of their needs. Initial assessments of these two people reflected their views on how they wish to express the Jewish faith. One of the people who recently came to live at the home told me “ I am not very religious and the staff understand this”. The records of medicines received, administered and returned to the pharmacist were all complete. I found that the medication for each of the people case tracked was accurately recorded. There were also personalised medication profiles on how individuals responded to taking medication. The
Clara Nehab House DS0000010422.V333444.R01.S.doc Version 5.2 Page 6 profile from one of person case tracked explained that they could become anxious if new medication is given to them. The profile told staff that they should take time and explain any changes to the person’s medication. I spoke with staff who were aware of this issue and what action to take. The general practitioner had been consulted on what each medication does and this had been recorded as part of the person’s medication profile. Another person who self medicates her pain relieving medication had been assessed with the support of the general practitioner to ensure this was safe. This had been recorded in the person’s care plan and medication profile. I spoke with people who live at the home who told me that they are provided with regular activities. I observed that activities were taking place at various times throughout the day. People spoken to explained that they were supported to practise the Jewish faith. People are supported to maintain contact with Synagogue and other organisations of the Jewish community. People spoken to confirmed that staff understood the Jewish culture and religion. The staff I spoke to were able to demonstrate an understanding of Jewish culture and history. The menu showed that two options are offered at each meal. The home provides a kosher diet for people living at the home. I spoke with a number of people who told me that this was the preferred diet. People who live at the home were generally pleased with the quality of the food provided. People told me that they understood how to make a complaint. They also felt that any complaints they raised would be dealt with in a sensitive manner. There had been ten complaints since the last inspection. Action had been taken to address these complaints. If the complaint highlighted a need for improvement in care practice this had been addressed. Bedrooms were personalised with items of furniture and pictures belonging to people who live at the home. The registered manager explained that further training was planned. A training plan was in place. This showed that training is planned to ensure that staff continue to be able to effectively meet the needs of people. A number of staff are doing the National vocational qualification at level 3. A deputy manager is currently doing the registered managers award. Also training on continence promotion, Person centred approaches to the care of people with dementia, communication and care planning has been provided for staff. Staff had also received training in aspects of the Jewish religion and of the history of Jewish people. This enabled them to understand the cultural and religious needs of the people they are caring for. The home has a system for obtaining the views of the quality of the service it provides and ensures that any areas for improvement are addressed. A survey of the views of people who live at the home, relatives and professionals was in place.
Clara Nehab House DS0000010422.V333444.R01.S.doc Version 5.2 Page 7 I saw that there were records of supervision sessions that had been held with staff. These had covered issues relating to the care of people living at the home and the development of the individual staff members. The deputy manager explained that supervision is provided both in small groups and individually. The deputy manager was able to show me records to confirm that she has begun to appraise staff. Fire drills were taking place and the fire alarm was tested regularly. The system had been regularly checked. The inspector found that the fire risk assessment included an assessment of all the potential fire risks in the home. The home has an effective system for monitoring accidents to ensure the safety of people who live at the home. What has improved since the last inspection?
All areas for improvement identified at the last key and random inspections had been addressed. I found that the care plans of all the people case tracked were detailed and clearly identified how the needs of people would be met. Care plans were personalised, and referred to the cultural needs of people. This included whether or not they wish to take part in religious practices. There was also information on peoples’ interests and previous occupations. The registered manager explained since the last inspection a more effective system had been put in place to ensure that care plans were reviewed. The registered manager and the deputy go through the care plans for each person living at home. Any changes are then recorded in their care plans and risk assessments. I found that care plans had been reviewed and there was evidence to show that where changes had occurred to peoples’ needs these had been recorded. If necessary the appropriate professionals had been consulted to ensure that changes in needs could be met safely. Since the last inspection tissue viability assessments have been put in place. One of the people case tracked had been identified in both his initial assessment and care plan is having a risk of developing pressure sores. A referral had been made to the district nurses and the necessary treatment had been provided. Nutritional assessments had been put in place since the last inspection. These recorded the level of risk and dietary needs of the people case tracked. The weight of people case tacked was monitored regularly and any changes were noted in their care plan and nutritional risk assessment. At the last inspection it was found that one of the people case tracked had an oxygen cylinder in their bedroom. There is now a risk assessment in place to
Clara Nehab House DS0000010422.V333444.R01.S.doc Version 5.2 Page 8 ensure the safety of people living at home. This identifies potential fire risks that may be caed by the use of the oxygen cylinder. A sign alerting people to the presence of the oxygen cylinder has been put on the bedroom door. There had been two complaints to the Commission one of which was anonymous. These concerned the need to improve the homes environment, staffing levels and care practice. A number of issues were found to have been proven after investigation. All these issues have now been addressed. There had been two adult protection investigations since the last key inspection. These concerned how medical care was obtained when peoples needs change. The registered manager and deputy manager responded positively to these issues. A more detailed review in process has been put in place to ensure that any changes in a care or medical needs of people living at home are addressed promptly. The registered manager explained that since the last inspection a number of new items of furniture had been purchased. I saw that these were placed around the home benefiting the people who live there. The registered manager was able to confirm that this work had been completed and that all the mixer valves have now been replaced. The environment has been improved since the last inspection, this includes ongoing decoration. The registered manager had a plan of work to be carried out to ensure that the environment in which people live is homely and safe. A review of the kitchen layout has been carried out. As a result of this some minor alterations to the kitchen will be carried out. Records were available to show the ongoing maintenance of the home is being carried out. The contractor has reviewed the boilers. The registered manager showed me evidence to confirm that the boilers of hot water system are functioning appropriately. The contractor carries out a monthly check to ensure that the boilers are working within safe limits. The registered manager showed me quotes for the cost of replacing the windows and frames. He has agreed that the work will begin in July 07 and was able to show evidence for this. The registered manager explained that since the last inspection he has regularly carried out a review of the level of staffing. This will ensure that sufficient staff are available to meet the needs of people living at home. As part and pre-inspection in information sent to me I saw an example of these reviews. The registered manager explained that he has increased the number of staff on duty in the morning to four. He has done this by providing an 8-1 shift. Staff spoken to said that this improved their ability to care for people in the morning when they that need to be assisted with personal care. Clara Nehab House DS0000010422.V333444.R01.S.doc Version 5.2 Page 9 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Clara Nehab House DS0000010422.V333444.R01.S.doc Version 5.2 Page 10 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Clara Nehab House DS0000010422.V333444.R01.S.doc Version 5.2 Page 11 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 13 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The statement of purpose is an accurate description of the service provided. People’s needs are assessed prior to admission to the home to ensure they receive the care and support they need. EVIDENCE: I spoke with people who live at the home who informed me that they had received information on what the home provided before deciding to come to live at the home. People had also visited the home before they were admitted. I found that the needs of the people case tracked were within a range of those specified in the statement of purpose. The statement of purpose also identified
Clara Nehab House DS0000010422.V333444.R01.S.doc Version 5.2 Page 12 the skills and staffing resources that are to be available to meet the needs of people living at home. Clara Nehab House provides care for people of the Jewish faith. People spoken to told me that the home meets their religious and cultural needs. The home support people in the practice of the Jewish faith ensuring that contact is maintained with local synagogues and the wider Jewish community. Training had been provided in the religious, history and culture of the Jewish people. People live at the home told me they felt that staff understood their cultural and religious needs. Two of the people case tracked had recently come to live at the home. They had detailed assessments of their needs. As part of the assessment process, information on the needs of people had been obtained from social care and health professionals. The initial assessments also provided information on the person’s life history. Initial assessments of these two people reflected their views on how they wish to express the Jewish faith. One of the people who recently came to live at the home told me “ I am not very religious and the staff understand this”. The initial assessments for the two people case tracked identified their specific personal care needs. The initial assessments of one of the people case tracked highlighted the importance of the person’s involvement in their personal care. This was reflected in their care plan. Staff spoken to understood and were able to explain how this need was met. Clara Nehab House DS0000010422.V333444.R01.S.doc Version 5.2 Page 13 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7 8 9 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People’s personal, social and medical care needs are fully planned for. People who use the service are fully protected by safe procedures for handling medication. People’s right to privacy is supported. EVIDENCE: I found that the care plans of all the people case tracked were detailed and clearly identified how the needs of people would be met. The registered manager explained that all care plans had been rewritten in consultation with people who live at home. In this way it had been possible to ensure that there was detailed information on how they were to be met. Clara Nehab House DS0000010422.V333444.R01.S.doc Version 5.2 Page 14 Care plans were personalised and referred to the cultural needs of people. This included whether or not they wish to take part in religious practices. There was also information on peoples’ interests and previous occupations. People I spoke to told me that they felt staff understood the needs. I observed that staff took time to understand people who live at home and always do things in the way they had been asked. The registered manager explained since the last inspection a more effective system had been put in place to ensure that care plans were reviewed. The registered manager and the deputy go through the care plans for each person living at home. Any changes are then recorded in their care plans and risk assessments. I found that care plans had been reviewed and there was evidence to show that where changes had occurred these had been recorded. If necessary the appropriate professionals had been consulted to ensure that changes in needs could be met safely. Detailed nutritional, tissue viability, falls and manual handling assessments have been put in place. Since the last inspection tissue viability assessments have been put in place. One of the people case tracked had been identified in both his initial assessment and his care plan as having a risk of developing pressure sores. A referral had been made to the district nurses and the necessary treatment had been provided. Nutritional assessments had been put in place since the last inspection. These recorded the level of risk and dietary needs of the people case tracked. The weight of people case tracked was monitored regularly. Any changes were noted in their care plan and nutritional risk assessment. At the last inspection it was found that one of the people case tracked had an oxygen cylinder in their bedroom. There is now a risk assessment in place to ensure the safety of people living at home. This identifies potential fire risks that may be caused by the use of the oxygen cylinder. A sign alerting people to the presence of the oxygen cylinder has been put on the bedroom door. Diary notes showed that the people case tracked had access to their general practitioner when necessary. Diary notes also confirmed that where the general practitioner had recommended specific medical interventions these were followed up and put in place. The records of medicines received, administered and returned to the pharmacist were all complete. Medicines were stored safely. All medicines are stored at the appropriate temperature. No controlled drugs are currently held in the home. I found that the medication for each of the people case tracked was accurately recorded. There were also personalised medication profiles on how individuals responded to taking medication. The profile from one of person case tracked
Clara Nehab House DS0000010422.V333444.R01.S.doc Version 5.2 Page 15 explained that they could become anxious if new medication is given to them. The profile told staff that they should take time and explain any changes to the person’s medication. I spoke with staff who were aware of this issue and what action to take. The general practitioner had been consulted on what each medication does and this had been recorded as part of the person’s medication profile. Another person self medicates her pain relieving medication had been assessed with the support of the general practitioner to ensure this was safe. This had been recorded in the persons care plan and medication profile. Changes to medication have been recorded. The general practitioner had signed the changes on the medication administration chart. Medicines held for the people case tracked corresponded with the changes made by the general practitioner. Training recently has been provided on the safe administration of medicines. I spoke with staff and found they were clear about their responsibilities and how to handle medicines safely. Training records also contained certificates confirming that this training had taken place. I observed staff administering medication and confirm that this was done safely. Clara Nehab House DS0000010422.V333444.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12 13 14 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at the home are provided with varied activities to meet their needs. People living at the home are supported to maintain contact with relatives and other representatives of their choice. People living at the home are able to make choices about how they live in the home. The menu reflects the preferences of people living at the home and offers a balanced diet. EVIDENCE: I spoke with people who live at the home who told me that they are provided with regular activities. I observed that activities were taking place at various times throughout the day. A film group took place in the morning. This was well attended and people appear to enjoy the film. In the afternoon there were games and discussions for people in the home to participate in. People spoken to told me that they enjoyed the activities provided by the home. One person told me “ there are a lot of activities to choose from. But they dont make you do anything”. An activities program is in place. People spoken to
Clara Nehab House DS0000010422.V333444.R01.S.doc Version 5.2 Page 17 told me that these activities are provided. One person spoken to said, “ I particularly like the musical evenings.” I observed that staff spend time talking with people who live at the home and listening to what they had to say. Peoples’ interests were recorded as part of their care plans. People spoken to explained that they were supported to practise the Jewish faith. People are supported to maintain contact with Synagogue and other organisations of the Jewish community. People spoken to confirm that staff understood the Jewish culture and religion.The staff I spoke to were able to demonstrate an understanding Jewish culture and history. A relative spoken to told me that there were no restrictions on visiting the home. People who are the home told me that they could see visitors in private if they wish to. Diary notes showed that people living at the home had regular contacts with family, friends and the wider community. The menu showed that two options are offered at each meal. The home provides a kosher diet for people living at the home. I spoke with a number of people who told me that this was the preferred diet. People who live at the home were generally pleased with the quality of the food provided. A person who lives at the home said, “ the food is good”. Another person commented about the choice of food offered and that staff had “asked about what food I like”. There was specific guidance on individual plans where they had dietary needs. I saw that meals were well presented and they were provided in a relaxed manner. Sufficient staff were available, and when necessary, people who live at home were observed being assisted to eat. Clara Nehab House DS0000010422.V333444.R01.S.doc Version 5.2 Page 18 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service are confident that their complaints will be listened to, taken seriously and acted upon. The home’s procedures protect people from abuse. EVIDENCE: People told me that they understood how to make a complaint. They also felt that any complaints they raised would be dealt with in a sensitive manner. The complaints policy explained how to make a complaint and how it would be dealt with. The complaints record showed actions taken to resolve complaints. There had been ten complaints since the last inspection. Action had been taken to address these complaints. If the complaint highlighted a need for improvement in care practice this had been addressed. There had been two complaints to the Commission one of which was anonymous.These concerned the need to improve the homes environment, staffing levels and care practice. A number of issues were found to have been proven after investigation. All these issues have now been addressed.
Clara Nehab House DS0000010422.V333444.R01.S.doc Version 5.2 Page 19 There had been two adult protection investigations since the last key inspection. These concerned how medical care was obtained when peoples needs change. The registered manager and deputy manager responded positively to these issues. A more detailed review in process has been put in place to ensure that any changes in a care or medical needs of people living at home are addressed promptly. There were comprehensive policies on handling abuse and protection. I found that staff had received training on adult protection matters. People living at the home felt confident that any concerns they raised would be handled sensitively and appropriately. Staff had been on Barnets adult protection training. Clara Nehab House DS0000010422.V333444.R01.S.doc Version 5.2 Page 20 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People live in a home that provides a safe and homely environment. The home is clean and hygienic. EVIDENCE: I walked round the home and found that it is appropriately decorated and furnished. There is a passenger lift providing access for people who live at the home. The registered manager explained that since the last inspection a number of new items of furniture had been purchased. I saw that these were placed around the home benefiting the people who live there. The registered manager was able to confirm that this work had been completed and that all the mixer valves have now been replaced.
Clara Nehab House DS0000010422.V333444.R01.S.doc Version 5.2 Page 21 The environment has been improved since the last inspection, this includes ongoing decoration.The registered manager had a plan of work to be carried out to ensure that the environment in which people lived is homely and safe. A review of the kitchen layout has been carried out. As a result of this some minor alterations to the kitchen will be carried out. Records were available to show the ongoing maintenance of the home is being carried out. Bedrooms were personalised with items of furniture and pictures belonging to people who live at the home. A person who lives at the home said, “ my bedroom is nice.” . The contractor has reviewed the boilers. The registered manager showed me evidence to confirm that the boilers of hot water system are functioning appropriately. The contractors carried out a monthly check to ensure that the boilers are working within safe limits. The registered manager showed me quotes for the cost of replacing the windows and frames. He has agreed that the work will begin in July 07 and was able to show evidence for this. Appropriate measures are in place to prevent cross infection. The home has detailed policies on the prevention of cross infection. Staff have received training on infection control measures. Staff spoken to understood how to work to minimise the possibility of cross infection. Staff confirmed that they had access to disposable gloves and aprons. Liquid soap and paper towels were available throughout the home. Clara Nehab House DS0000010422.V333444.R01.S.doc Version 5.2 Page 22 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27 28 29 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Sufficient staff are available at all times to meet the needs of people who live at the home. Staff do have all the skills to meet all the assessed needs of people who live at the home. People who live at the home are protected by the home’s recruitment practices. EVIDENCE: The registered manager explained that since the last inspection he has regularly carried out a review of the level of staffing. This will ensure that sufficient staff are available to meet the needs of people living at home. As part and pre-inspection in information sent to me I saw an example of these reviews. The registered manager explained that he has increased the number of staff on duty in the morning to four. He has done this by providing an 8-1 shift. Staff spoken to said that this improved their ability to care for people in the morning when they that need to be assisted with personal care. Clara Nehab House DS0000010422.V333444.R01.S.doc Version 5.2 Page 23 I observed that staff were able to effectively meet the needs of people living at home. People living at the home told me that staff are available to meet their needs. The rota showed that a consistent level of staffing is maintained on each floor. I observed that staff were available at key times of the day (e.g. mealtimes) to assist people. Staff were also observed to spend time with people both individually and in small groups. This allowed more attention to the individual needs of people who live at the home. Training records and certificates showed that since the last inspection staff had received training in first aid and dementia care. I spoke with staff who confirmed that they had this training. They understood the dementia care needs of one of the people case tracked. Staff at the home had undergone training in all the statutory required areas. I was able to see certificates that confirmed that training had been provided. Staff spoken to confirmed that they had received training and this had made them confident in their ability to support the needs of people. The registered manager explained that further training was planned. A training plan was in place. This showed that training is planned to ensure that staff continue to be able to effectively meet the needs of people. This would include a number of staff doing the National vocational qualification at level 3. A deputy manager is currently doing the registered managers award. Also training on continence promotion, Person centred approach is the care of people with dementia, communication and care planning. Staff had also received training in aspects of the Jewish religion and of the history of Jewish people. This enabled them to understand the cultural and religious needs of the people they are caring for. The registered manager explained that at present 50 of staff have achieved the National Vocational Qualification in care. Staff spoken to felt that this training has given them important skills, which they use daily in their work with people who live at the home. I examined staff files and found that these contained all the required information relating to their recruitment. I found that there were no unexplained gaps in the employment history of recently recruited staff. A health check has been carried out to ensure that staff coming to work at the home could safely meet the needs of people. Clara Nehab House DS0000010422.V333444.R01.S.doc Version 5.2 Page 24 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31 33 35 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Appropriate management structures are in place to ensure that people receive the care they need. People who live at the home are consulted about the quality of the service provided and are encouraged to make suggestions for improvement. People who live at the home have their financial interests protected by the home’s procedures. People who live at the home and staff are protected by the home’s health and safety procedures. EVIDENCE: Clara Nehab House DS0000010422.V333444.R01.S.doc Version 5.2 Page 25 I observed that the registered provider spent time working with staff and people who live at the home. The registered manager has extensive experience of working with older people and those with dementia. The registered manager was able to show me that he has introduced effective systems to ensure that people living at the home received the care that they need. He is working closely with the deputy manager to ensure that staff are supported to deliver the best possible outcomes for people living at the home. The home has a system for obtaining the views of the quality of the service it provides and ensures that any areas for improvement are addressed. A survey of the views of people who live at the home, relatives and professionals was in place. Staff meetings are taking place to ensure staff are aware of plans to develop the service. The home does not hold money for people who live at the home. The home invoices their families or the relevant social service department for any expenditure made on their behalf. A system is in place to ensure receipts are obtained for any expenditure. Staff received regular supervision so that they can effectively meet the needs of people living at the home. I spoke with staff who told me that they had received supervision. They felt that this had been useful and enabled them to meet the needs of people more effectively. I saw that there were records supervision sessions that had been held with staff. These had covered issues relating to the care of people living at the home and the development of the individual staff members. The deputy manager explained that supervision is provided both in small groups and individually. The deputy manager was able to show me records to confirm that she has begun to appraise staff. Fire drills were taking place and the fire alarm was tested regularly. The system had been regularly checked. The inspector found that the fire risk assessment included an assessment of all the potential fire risks in the home. I questioned staff on the fire safety procedures and found that they understood fire safety issues. All health and safety policies were available. Certificates for gas, legionella and electrical testing were in date. COSHH guidance was in place and chemicals were stored safely. I discussed health and safety issues with staff and they demonstrated their understanding. The home has an effective system for monitoring accidents to ensure the safety of people who live at the home. The temperature of food delivered to and cooked was recorded. The temperatures of the fridges and freezers were recorded and within safe limits. Clara Nehab House DS0000010422.V333444.R01.S.doc Version 5.2 Page 26 Clara Nehab House DS0000010422.V333444.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 Clara Nehab House DS0000010422.V333444.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Clara Nehab House DS0000010422.V333444.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Harrow Office 4th Floor Aspect Gate 166 College Road Harrow Middlesex HA1 1BH National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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